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Online Questionnaire for Group Therapy Listing

In order to have your groups listed, you must be a current paid-up member of WGPS.

Part I: Professional Information

Name:

Degree:

Telephone:

Email:

Office Address:

City: Zip:

Are you licensed for independent practice? Yes No

License No

AGPA Member:

Are you a Certified Group Psychotherapist (CGP)?

Part II: Current on-going groups you are leading:

1. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

2. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

3. Type of Group*:

Age Range:

Frequency of Group:

Where does the Group meet?

When does the Group meet? (Day and time):

*Sample Listing:
1.    Type of Group*: Eating disorders
       Age Range:   20’s – 40’s        Gender: Women   
       Frequency of Group:     1x weekly – ongoing

       Where does the Group meet?       Ossining
       When does the Group meet? (Day and time):Tuesday 730-900pm

** Overall categories will include: Children and Adolescent, Adult, Training and Supervision etc.
*** If you plan to start a group, provide us with as much detail as you can and we will list it as a pending or with a target date.

There will be a disclaimer posted on the WGPS website that this listing is for informational purposes only and that this particular therapist should be called for detailed information.

I request that WGPS post the above information about my group(s) on www.WGPS.org .

 

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